Strengthen and Stabilize Rural Health Workforce
Adds rural residencies and training rotations, grow-your-own pipelines such as Scrubs Camp, train-in-place programs, recruitment and retention grants and technology that extends staff.
RHTP state profile · North Dakota
North Dakota Rural Health Transformation Program
North Dakota received $198.9 million in Year 1 of the $50 billion federal Rural Health Transformation Program, 29th of 50 states. North Dakota Health and Human Services (ND HHS) runs the program, which funds four initiatives for rural and tribal communities outside Fargo, West Fargo, Grand Forks and Bismarck, from workforce and healthy living to care closer to home and health technology.
Year 1 awards, all 50 statesND: $198.9M
Texas $281.3MNew Jersey $147.3M
$198.9MYear 1 award, 29th of 50
4Funded initiatives
50 / 53North Dakota counties have no city treated as urban
ND HHSNorth Dakota Health and Human Services
Spending data in the RHTP Year One Report covers December 29, 2025 to July 31, 2026, the latest CMS reporting window.
At a glance
North Dakota's program at a glance
The award is fixed for the year. Spending moves every quarter, so North Dakota's section of the RHTP Year One Report tracks how much was put to work, and with whom, through July 31, 2026. It updates after each CMS data release.
Year 1 award$198,936,969, 29th of 50 states
Run byNorth Dakota Health and Human Services
Budget Period 1December 29, 2025 to October 30, 2026
Initiatives4
Fully rural counties50 of 53
Spending data through July 31, 2026North Dakota's section of the Year One Report →Initiatives
What does North Dakota's RHTP fund?
North Dakota's RHTP funds four initiatives, which ND HHS calls pillars: workforce, healthy living, care closer to home and health technology. Care closer to home holds the largest share of the Year 1 budget, about $116 million, and every funding opportunity ND HHS posts maps to one of the four.
Make North Dakota Healthy Again: Preventive Care, Healthy Eating
Launches Eat Well ND and ND Moves Together, with community gardens, walking programs, before-school PE, behavioral health promotion and value-based payment for rural providers.
Bring High-Quality Health Care Closer to Home
Funds rightsizing help for rural hospitals and clinics, Clinics Without Walls telehealth and remote monitoring, safety-net services, ambulance upgrades, transportation and care coordination.
Connect Tech, Data and Providers for a Stronger North Dakota
Modernizes health data systems and EMRs and adds shared technology purchasing, AI tools, pharmacy kiosks and plans for drone delivery of supplies and lab samples.
Recipients by initiative are in North Dakota's section of the RHTP Year One Report.
Source documents
North Dakota's full plan is public
The approved plan has more detail than any summary: goals, partners, metrics and timelines for each initiative. Read it before responding to a North Dakota funding opportunity.
PDFND HHSNorth Dakota RHT Program Project NarrativeThe full plan from ND HHS, including all four initiatives and North Dakota's policy commitments.PDFND HHSNorth Dakota RHT Project SummaryND HHS's short overview of the plan, with five-year amounts for each initiative.PDFND HHSNorth Dakota RHT Year One Budget NarrativeThe Year 1 budget CMS approved, by initiative.PDFND HHSNorth Dakota RHT Project AppendicesThe workplan for every activity under the four initiatives, plus rural health data.PDFCMSCMS 50-State SpotlightsCMS's short profile of each state's program, including North Dakota's.PDFCMSCMS State Project AbstractsEach state's own summary, side by side.
County with no urban city (50)County with an urban city (3)
Eligibility
Which North Dakota counties are eligible for RHTP funding?
All 53 North Dakota counties can receive RHTP funding for work that serves rural or tribal residents, because ND HHS treats only four cities as urban: Fargo, West Fargo, Grand Forks and Bismarck. That leaves 50 counties with no urban city; Cass, Grand Forks and Burleigh counties hold those cities, and their rural areas can still qualify. Groups inside the four cities qualify only if at least half the people they serve are rural North Dakotans or the work targets rural residents. Each funding opportunity states its own eligibility.
How to apply
How can North Dakota providers apply for RHTP funding?
North Dakota providers apply through ND HHS funding opportunities posted on its RHTP Funding Opportunities page, with applications submitted through Qualtrics. ND HHS also contracts with partner organizations, which issue some funding opportunities of their own. Providers and vendors don't apply to CMS directly.
- Match the work to an initiative.Funding only goes to work that fits one of the four pillars.
- Watch for new rounds.Sign up for ND HHS RHTP email updates and check the Funding Opportunities page. Rounds have stayed open for as little as a few weeks.
- Check rural eligibility.Most rounds require serving rural or tribal residents. Groups in Fargo, West Fargo, Grand Forks and Bismarck qualify only if at least half the people they serve are rural.
- Plan for federal rules.Register in SAM.gov, which is standard for federally funded grants. Grant recipients follow federal grant, reporting and audit rules, and a Single Audit applies at $1 million or more in federal spending a year.
- Ask ND HHS directly.Send questions through the RHTP FAQ survey linked in each funding opportunity, or email rhtp@nd.gov.
Federal terms
Four rules that shape every award
Federal terms follow the money down to every North Dakota recipient.
Grants and contracts carry different obligations
A subaward makes your organization a subrecipient that carries out part of the program, with federal reporting and audit requirements. A contract pays for goods or services, with lighter requirements.
New rounds follow CMS budget approval
States can't post funding opportunities until CMS approves their budget, so windows can open months into a budget period.
Workforce incentives need a rural commitment
Recruitment and retention payments require clinicians to commit to serving rural communities for at least five years.
Recipients must disclose the federal funding
Under the Stevens Amendment, websites, social posts and other public materials about a funded project must name the federal funding.
Allowable costs
What can North Dakota's RHTP funding pay for?
North Dakota's RHTP funding can pay for work on existing facilities, uncovered care, technology and administration, within federal caps on each use. Applied to North Dakota's Year 1 award, the maximums are:
Capital and infrastructure20% of award
About $39.8M
Provider payments15% of award
About $29.8M
Administrative costs10% of award
About $19.9M
Rural Tech Catalyst Fund10% or $20M, whichever is less
About $19.9M
Replacing an existing EMR system5% of award
About $9.9M
Provider payments and capital
Provider payments cover services insurance doesn't pay for, quality bonuses and outcome-based payments tied to North Dakota's plan. They can't raise rates for services providers already bill.
Capital funds go to existing facilities: renovations, accessibility upgrades, HVAC and like-for-like equipment replacement.
Off limits
- New construction, demolition and major expansions
- Cosmetic work such as painting, carpet or decor
- Clinician salaries at facilities that use non-compete clauses
- Home broadband installation and service
- Costs already covered by other federal or state funding
Policy commitments
North Dakota's policy commitments carry deadlines
North Dakota made six policy commitments in its application. Five are done, four of them through laws passed in the January 2026 special session. CMS can reduce or recover funding if the last one slips or a finished one is reversed.
Presidential Fitness Test
Require students to take the Presidential Fitness Test
HB 1621 signed January 23, 2026; testing starts by the 2027-28 school yearSNAP food restriction waiver
Restrict SNAP purchases of soft drinks, energy drinks and candy
USDA approved December 10, 2025; in effect September 1, 2026Nutrition education for physicians
Require one hour of nutrition and metabolic health continuing medical education
SB 2401 signed January 23, 2026Physician assistant licensure compact
Join the PA Licensure Compact
HB 1622 signed January 23, 2026Pharmacist prescribing
Let pharmacists order certain lab tests and prescribe certain medications
SB 2402 signed January 23, 2026Dental hygienist anesthesia
Let dental hygienists give local anesthesia under general or indirect supervision
Board of Dental Examiners rules went to the Administrative Rules Committee in March 2026North Dakota already belongs to the physician, nurse, EMS and psychology licensure compacts.
Years 2 to 5
$40B
Future awards depend on progress
Year 1 is not a guaranteed annual amount. CMS plans up to $40 billion more nationwide through 2030 and rescores every state each year on progress, data and policy actions.
Unobligated money leaves the state
Funds not obligated by the end of a budget period can't be obligated later and are redistributed to other states.
Funds can be clawed back
CMS can withhold, reduce or recover money for unallowable costs, unapproved plan changes or missed policy commitments. States get 90 days to fix a violation, and most decisions can't be appealed.
Oversight is growing
CMS's Office of Rural Health Transformation plans site visits in all 50 states in 2026. Audits start in 2027.
Method
Reading North Dakota's spending data
Use the numbers in North Dakota's section of the RHTP Year One Report to understand direction and pace, not as an audit.
Put to work is not paid out
Obligated money is signed to a contract or grant. Cash reaches recipients later.
Through July 31, 2026 only
The data covers December 29, 2025 to July 31, 2026, as North Dakota reported it to CMS. Commitments made after July 31, 2026 are not counted yet.
Recipients sit inside line items
The CMS report has no recipient column. Search North Dakota's line item descriptions by name.
Quarterly refresh
CMS updates the data after each quarterly state report, starting with the November 30, 2026 filing.
Announcements
Major North Dakota announcements
ND HHS says it has allocated North Dakota's full Year 1 award ahead of the October 30 deadline and has submitted its Year 2 budget to CMS.
ND HHS opens about $50.5 million in new funding, including $22 million for rural ambulance equipment and money for telehealth, remote monitoring, EMR upgrades and childcare for rural health workers.
ND HHS opens $40 million for clinical equipment at rural hospitals, about 20 awards of roughly $2 million each.
ND HHS opens more than $20 million in workforce, safety-net and hospital rightsizing grants, including $15 million for rural safety-net services.
ND HHS opens its first RHTP round: about $10 million in workforce retention grants for the state's 37 critical access hospitals.
ND HHS announces CMS approval of $194.8 million of the Year 1 budget.
Gov. Kelly Armstrong signs special session bills that fund the program and enact four of the state's policy commitments.
Awards announced after July 31, 2026 are not in the CMS spending data yet. They will appear after the next CMS refresh.
Timeline
Key dates
- Dec 10, 2025USDA approves North Dakota's SNAP food restriction waiver
- Dec 29, 2025Year 1 award; Budget Period 1 begins
- Jan 23, 2026Special session bills signed
- Feb 25, 2026CMS approves $194.8 million of the Year 1 budget
- Jul 31, 2026End of the first CMS reporting window; Year One Report spending data runs through this date
- Sep 1, 2026SNAP food restrictions take effect
- Oct 30, 2026Deadline to obligate Year 1 funds; Budget Period 1 ends
- Nov 30, 2026Quarterly reports due; CMS refreshes funding data
- Sep 30, 2027Deadline to spend Year 1 funds
- 2030Final year of the five-year program
Implications
What this means
For rural hospitals
Care closer to home holds the largest share of North Dakota's Year 1 budget, and hospitals have already seen a $40 million clinical equipment round, $10 million in retention grants for critical access hospitals and rightsizing help delivered with Eide Bailly. Expect Year 2 rounds to follow the same four pillars once CMS sets the Year 2 amount.
For partners and vendors
North Dakota funds mostly through grants, and ND HHS is also contracting with partner organizations that issue their own opportunities. Technology rounds so far cover EMR upgrades, telehealth, remote monitoring, AI, staff-extending technology and pharmacy kiosks. Partnering with the rural hospitals, clinics and ambulance services that apply is one route in.
For applicants and grantees
Build tracking for the measures North Dakota reports to CMS before an award lands. Subrecipients can't opt out of reporting, and their results feed North Dakota's annual rescoring. Year 1 funds must be spent by September 30, 2027.
FAQ
North Dakota RHTP FAQs
Who runs North Dakota's Rural Health Transformation Program?
North Dakota Health and Human Services (ND HHS) runs North Dakota's Rural Health Transformation Program, using federal funding from the Centers for Medicare & Medicaid Services (CMS). ND HHS manages the state's plan, posts funding opportunities and answers questions through its RHTP FAQ survey and at rhtp@nd.gov. The program is North Dakota's share of the $50 billion federal Rural Health Transformation Program.
How much RHTP funding did North Dakota receive?
North Dakota received $198,936,969 for Year 1 of the Rural Health Transformation Program, 29th of 50 states. Every state got $100 million in baseline funding, and the rest of North Dakota's award was based on its rural needs, its policy commitments and the strength of its plan. Later years depend on North Dakota's progress.
Can North Dakota RHTP funding pay for construction?
No. RHTP funds can't pay for new construction, demolition or major expansions. Up to 20% of North Dakota's award each year, about $39.8 million in Year 1, can go to work on existing facilities, such as renovations, accessibility upgrades, HVAC replacement and like-for-like equipment replacement.
Can North Dakota providers use RHTP funding to pay for patient care?
Only for care that insurance doesn't already pay for. Provider payments can cover nonreimbursed services, quality bonuses and outcome-based payments tied to North Dakota's plan, up to 15% of the award each year, about $29.8 million in Year 1. They can't raise rates for services providers already bill.
Where can I see how North Dakota is spending its RHTP funding?
The RHTP Year One Report tracks how much of North Dakota's award was put to work through July 31, 2026, by initiative and recipient, using state-reported data from CMS, and is updated after each CMS data release. Rounds that closed after July 31, such as the $22 million rural ambulance equipment round, will appear after the next CMS refresh.
The Alliance
RHT Alliance members serving North Dakota
These RHT Alliance members serve North Dakota providers, with support that spans virtual nursing, virtual care, remote monitoring, EHR and health data, diagnostics, patient education and grant writing.
Azalea HealthCloud EHR and billing with AI-assisted charting for rural hospitals and clinics.
CorstrataTelehealth access to board-certified wound, ostomy and continence nurses.
Equum MedicalTelehealth-enabled physician coverage across specialties.
Health Recovery SolutionsRemote patient monitoring and care management at home.
InterSystemsHealth data platforms and interoperability.
Medical Equipment SourceDigital pathology, mobile labs and lab equipment services.
Rural Health Transformation Funding NetworkGrant writing support for RHTP funding opportunities.
Self Care DecisionsEvidence-based triage that directs patients to the right level of care.
Solid StartsInfant feeding guidance and education for families, built by pediatric feeding specialists.
Teledentistry.com24/7 virtual dental evaluations and emergency triage.
VitalChatVirtual nursing and continuous audio and video care across hospitals.
WebMD IgniteMedically reviewed patient education and outreach, including its HEART rural program.Follow North Dakota's money as it moves
The RHTP Year One Report tracks obligations, initiatives and recipients for all 50 states after each CMS data release.